Ligation and Embolization in One Procedure for Cavernovenous Leakage in 171 Patients with Drug-Resistant Erectile...

Area of Science:

• Urology
• Vascular Surgery
• Radiology

Background:

• Erectile dysfunction (ED) resistant to 5-Phosphodiesterase inhibitors can be caused by caverno-venous leakage (CVL).
• Pharmacologically-Challenged Penile Duplex Sonography (PC-PDS) and computed tomography cavernosography are diagnostic tools for CVL.

Purpose of the Study:

• To assess the effectiveness of simultaneous open surgical ligation and endovascular embolization for treating CVL in patients with ED.
• To evaluate clinical outcomes and patient-reported functional improvements post-procedure.

Main Methods:

• Prospective data collection from 171 patients with ED and CVL undergoing simultaneous ligation and embolization.
• Diagnosis confirmed by PC-PDS and cavernosography; exclusion of other ED causes and high thrombo-embolic risk.
• Primary endpoints included 3-month and end-of-follow-up Erection Hardness Scores (EHS) and International Index of Erectile Function (IIEF-5) scores.

Main Results:

• Mean PC-EHS significantly improved from 2.56 to 3.40 (p<.0001), with a drop in patients having PC-EHS<3 from 64.9% to 11.2% (p<.001).
• Significant improvements observed in IIEF-5 scores (10.68 to 15.89, p<.0001) and clinical EHS across various assessment methods.
• An overall erection improvement rate of 80.7% was achieved at the end of follow-up (mean 22.88 months).

Conclusions:

• Combined open and endovascular techniques offer an effective treatment for CVL-related ED.
• Thorough preoperative assessment and a 3-month hemodynamic evaluation are crucial for successful treatment outcomes.